tbuckley/cabot-search huggingface dataset:
Clinical Case 07—Acute myocardial infarction due to paradoxical embolism: a difficult and underrecognized diagnosis
Authors: Cátia Oliveira, Tânia Proença, Ana Pinho, Luís Santos, André Cabrita, Catarina Marques, Ana Filipa Amador, João Calvão, Catarina Costa, Miguel Carvalho, Ricardo Pinto, Ana Lebreiro, Filipe Macedo
Journal: Cardiovascular Research (2022)

Abstract Paradoxical embolism occurs when embolic material crosses from the venous to the arterial circulation through an intracardiac defect, such as a patent foramen ovale (PFO). Although rare, it may be a cause of acute coronary syndrome (ACS), requiring a high degree of clinical suspicion for diagnosis. We report a case of a 30-year-old man presenting in the emergency department with prolonged atypical left thoracic pain, electrocardiogram showing sinus rhythm with 1 mm ST-elevation in the inferior leads, and high-sensitivity troponin I elevation (maximum of 20 682 ng/L). The patient underwent emergent coronary angiography which showed apparently normal coronary arteries. The patient was then submitted to cardiac magnetic resonance that showed a recent transmural infarction of the inferior wall. (Figure 1). A right coronary branch was assumed as the culprit. Additional study was made, with trans-esophageal echocardiogram (TEE) with agitated saline test revealing a PFO with spontaneous right-left shunt (Figure 1). No intra-cavitary thrombus or other embolic source were found and the patient remained in sinus rhythm. Thrombophilia and auto-immune panel were negative. A presumptive diagnosis of paradoxical coronary emboli was made. PFO closure was performed with the Noblestich© system (a suture-based system). In conclusion, although paradoxical coronary artery embolism is an established cause of ACS, it requires a high degree of clinical suspicion for diagnosis. Recognition of this condition is important as it influences patients’ management and prognosis and percutaneous device closure of the PFO should be considered to prevent future embolic events. Figure 1A: Short axis cardiac resonance showing transmural late gadolinium enhancement in the inferior wall. B and C: Trans-esophageal echocardiography with Doppler signal (B) and agitated saline test (C) showing the PFO with shunting.
Oral Presentation No. 64 Elevated soluble glycoprotein VI, a specific predictor of bleeding risk in patients with chronic coronary syndromes undergoing percutaneous coronary intervention
Authors: Shqipdona Lahu*, Kristin Adler*, Gjin Ndrepepa, Katharina Mayer, Ralph Hein-Rothweiler, Isabell Bernlochner, Karl-Ludwig Laugwitz, Adnan Kastrati, Meinrad Gawaz, Steffen Massberg, Götz Münch
Journal: Cardiovascular Research (2022)

Abstract Background Whether plasma levels of soluble glycoprotein VI (sGPVI) are able to predict ischemic or bleeding risk in patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI) is not known. The objective of this study was to answer this question. Material and methods The present study included 317 patients out of 334 patients of the ISAR-PLASTER trial (randomized trial of 2 doses of revacept vs. placebo), who underwent PCI for CCS and had baseline plasma sGPVI levels available. Patients were categorized into three groups according to tertiles of sGPVI: low (n = 106; sGPVI ≤ 9.5 ng/ml), intermediate (n = 106; sGPVI ≤ 16.2 ng/ml) and high tertile of sGPVI (n = 105; sGPVI ≥ 16.5 ng/ml). The composite of death and myocardial injury (MI) at 48 hours after randomization served as a measure of ischemic risk, and Bleeding Academic Research Consortium (BARC) type 1 to 5 bleeding at 30 days as a measure of bleeding risk. Results and conclusions Baseline plasma levels of sGPVI (before PCI and revacept administration) correlated with bleeding (bleeding incidence among low, intermediate and high sGPVI tertile: 11.8%, 13.6%, and 25.8%, respectively; P = 0.005), but not with ischemic events (incidence of death/MI among low, intermediate and high sGPVI tertile: 25.0%, 21.9%, and 26.9%, respectively; P = 0.70). Revacept did not interact with these associations. Elevated plasma sGPVI levels are associated with an increased risk of bleeding but not ischemic complications after PCI in patients with CCS. Funding German Center for Cardiovascular Research, Deutsches Herzzentrum München, Federal Ministry of Education and Research, and advanceCOR.
Retracted: Clinical Case 28—Hyperacute synchronous cardiocerebral infarction in a patient with new-onset atrial fibrillation a rare case of MINOCA
Authors: Panteleimon E Papakonstantinou, Konstantinos Manousiadis, Ilianna Bei, Malamati-Eleni Lentza, Maria Panourgia, Dimitra Tachmetzidi-Papoutsi, Antonios Sideris
Journal: Cardiovascular Research (2022)

This abstract has been withdrawn. Please see: https://doi.org/10.1093/cvr/cvac183
Clinical Case 10—An unusual case of thrombocytopenia following transfemoral aortic valve implantation
Authors: Ana Débora Câmara de Sá, André Antunes, M Raquel Santos, Margarida Temtem, João Adriano Sousa, Bruno Silva
Journal: Cardiovascular Research (2022)

Abstract Clinical Case: An 85-year-old female patient with diabetes, hypertension, obesity, chronic kidney disease and severe aortic stenosis was submitted to transcatheter aortic valve implantation (TAVI). During procedure unfractionated heparin was administered. Intervention was performed without complications and she was discharged with platelet count of 116,000/μL. Fifteen days after (day 0), she was readmitted with dyspnea. Arterial blood gas showed hypoxemia and lactate levels of 5,8mmol/L. The ECG showed new-onset atrial fibrillation (AFib) with a rapid ventricular rate. Blood tests showed platelet count of 45,000/μL, D-dimers 2790ng/mL, worsening kidney function and high inflammation markers. An echocardiogram showed normofunctioning transcatheter aortic valve. Pulmonary embolism (PE) or respiratory infection with new-onset AFib were admitted. The patient started enoxaparin and an antibiotic. On day 4 the patient was oliguric needing dialysis. A CT Angiography was performed that excluded PE but showed several thrombus on the right atrium and appendix, right ventricle and on the abdominal aorta. Blood results showed hemolytic anemia. On day 8, the platelet count reached the nadir of 11 000/μL. At that time, differential diagnoses included thrombotic thrombocytopenic purpura (TTP), heparin-induced thrombocytopenia and sepsis-induced disseminated intravascular coagulation (DIC). Laboratory evaluation showed a near-normal coagulation profile and a PF4+ antibody. Enoxaparin was stopped; fondaparinux and plasma therapy were started. Platelet count took weeks to reach previous levels. The patient was discharged with a DOAC. It is usual to have some degree of thrombocytopenia after TAVI. In this case we have a complex and challenging scenario, properly handled, and with a good outcome.
Clinical Case 26—Is it possible to live with thrombosed left ventricular assist device (LVAD)?
Authors: Nina Dračina, Miodrag Golubović, Ranko Zdravković, Aleksandar Redžek, Mirko Todić, Andrej Preveden
Journal: Cardiovascular Research (2022)

Abstract LVAD HeartWare was implanted in a 63-year-old patient with end-stage dilated cardiomyopathy. The postoperative course was complicated by massive gastrointestinal (GI) bleeding that required surgical exploration of the GI tract. For the next 1.5 years, the patient has significantly improved functional capacity with proper LVAD function. A month before the incident, an alarm indicating a pump malfunction was recorded. The patient presents with congestive symptoms and an altered sound of LVAD. Laboratory indicates seven times elevated LDH values, low HGB and INR 3.03. Thrombophilia tests were negative. Echo examination does not indicate pump thrombosis, but the pump parameters show increased energy consumption (&amp;gt;6 W) and increased flow (&amp;gt;7 L/min). A diagnosis of LVAD thrombosis was made. Fibrinolytic therapy was contraindicated because of a history of GI bleeding, so a continuous infusion of heparin was started. Despite this, the patient's clinical condition deteriorates, and a decision was made to discontinue the LVAD, to prevent further hemolysis that led to acute kidney injury (AKI). The procedure was performed without endangering the patient. Massive hemolysis, however, leads to the progressive development of AKI requiring CVVHDF. Global respiratory insufficiency develops and mechanical ventilation was started. After six days of intensive treatment, the patient recovered and was discharged home with a thrombosed pump. For the next 2.5 years, the patient was in satisfactory condition during follow-ups, the pump was not explanted. Even sophisticated medical devices carry with them risks for the patient's life despite adequate management. Treatment of LVAD thrombosis depends on patient characteristics and pump-related factors.
Oral Presentation No. 107 Achieving higher efficacy without compromising safety with Factor XI inhibitors versus low-molecular-weight heparin for the prevention of venous thromboembolism in major orthopedic surgery – Systematic Review and Meta-Analysis
Authors: João Presume, Jorge Ferreira, Regina Ribeiras, Miguel Mendes
Journal: Cardiovascular Research (2022)

Abstract Background In recent years, many important advances have been seen in anticoagulation therapy. However, bleeding risk is still a major concern. Factor XI inhibition has emerged as a potential advantageous target to minimize this risk. Objectives We conducted a systematic review and meta-analysis of current evidence on factor XI inhibitors for thromboprophylaxis in major orthopedic surgery. Methods We performed a systematic search of electronic databases (Pubmed, CENTRAL, and Scopus) until May of 2022. Studies were considered eligible if they were RCTsevaluating factor XI inhibitors in thromboprophylaxis vs. low-molecular-weight heparins (LMWH). For analysis purposes, we considered efficacy (Venous Thromboembolism [VTE], symptomatic VTE) and safety (major and clinically relevant non-major [CRNM] bleeding events; major bleeding events; blood transfusion necessities; adverse events; major adverse events) outcomes. Results Overall, 4 RCTs were included, with a total of 2269 patients, 372 VTE events, and 50 major or CRNM bleeding events. Regarding efficacy outcomes, factor XI inhibitors were associated with a significant reduction in the incidence of VTE events (OR 0.50; 95%CI [0.36, 0.69]). Concerning safety outcomes, factor XI inhibitors significantly reducedmajor or CRNM bleeding events (OR 0.41 [0.22; 0.75]). It was also associated with a lower percentage of patients needing a blood transfusion, despite not meeting statistical significance (OR 0.69; 95%CI [0.32; 1.48]). Incidence of adverse events and major adverse events were similar between groups. Conclusion Factor XI inhibitors showed a significant reduction in the incidence of VTE and bleeding events among patients submitted to major orthopedic surgery.
Retracted: Oral Presentation No. 91 Valve-in-valve TAVI for treatment of degenerated surgical aortic bioprosthesis
Authors: Mariana Ribeiro Silva, Alberto Rodrigues, Cláudio Guerreiro, Gualter Santos Silva, Pedro Ribeiro Queirós, Mariana Brandão, Diogo Santos-Ferreira, Gustavo Pires-Morais, Bruno Melica, Lino Santos, Pedro Braga, Ricardo Fontes-Carvalho
Journal: Cardiovascular Research (2022)

This abstract has been withdrawn. Please see: https://doi.org/10.1093/cvr/cvac183
Poster No. 142 An unusal heart-kidney connection: from diagnosis to staging of renal cell carcinoma
Authors: Jéni Quintal, Paula Lopes, Joana Póvoa, Aissato Cassama, Ana Cristina Diogo, Vanessa Pereira
Journal: Cardiovascular Research (2022)

Abstract A 58-years-old man is admited in emergency department with complaints of 2-days le flank pain and hematuria. When questioned, he mentions 6-months bilateral low back pain. His medical history was relevant for tobacco consumption (80 pack-year) and acute myocardial infarction in 2011. During abdominal examination, a painless 7 cm mass is detected in the left abdominal flank. Blood tests were remarkable for macrocytic anemia, increased D-dimers and serum calcium levels and leukocytosis. A thoracoabdominal-pelvic CT was performed to exclude advanced neoplasia. A 15×13 cm heterogeneous renal lesion involving the lower half of the left kidney was shown. This lesion extended through the renal vein and suprarenal inferior vena cava (IVC) to the right atrium. Bilateral pulmonary thromboembolism and metastatic lesions in the liver, left adrenal gland, latero-aortic ganglia and lung parenchyma were also detected. A thrombus was confirmed in the IVC with extension to the Eustachian valve by echocardiography. Metastatic renal carcinoma was assumed and enoxaparin was started. A renal biopsy identified clear cell renal carcinoma (CCRC). Embolization of the left renal artery was performed and Palliative Care follow-up was started after multidisciplinary team discussion. Renal cell carcinoma accounts for 2% of all tumors in adulthood with its classic symptomatic triad (flank pain, hematuria, and palpable abdominal mass) occuring only 9% of cases, as does endovascular dissemination from the renal vein and IVC. It is associated with a median survival of 5 months. We emphasize the importance of complete clinical examination and the recognition of poor prognosis predictors of CRCL.
Retracted: Oral Presentation No. 089 Vascular access computed tomography angiography-derived iliofemoral calcium volume in the evaluation of vascular and bleeding complications after transfemoral TAVI
Authors: Mariana Ribeiro Silva, Joana Oliveira, Inês Rodrigues, Cláudio Guerreiro, Gualter Santos Silva, Mariana Brandão, Wilson Ferreira, Nuno Ferreira, Gustavo Pires-Morais, Bruno Melica, Lino Santos, Alberto Rodrigues, Pedro Braga, Francisco Sampaio, Ricardo Fontes-Carvalho
Journal: Cardiovascular Research (2022)

This abstract has been withdrawn. Please see: https://doi.org/10.1093/cvr/cvac183
Oral Presentation No. 112 Treatment of pulmonary embolism after paradoxical stroke
Authors: Mariana Martinho, Nuno Cotrim, Melanie Ferreira, Rita Calé, Filipa Ferreira, Vilma Grilo, Eugeniu Gisca, Ana Glória Fonseca, Ana Gomes, Tiago Judas, Hélder Pereira, Francisca Delerue
Journal: Cardiovascular Research (2022)

Abstract Introduction A patent foramen ovale (PFO) is often diagnosed in cryptogenic strokes and concurrent pulmonary embolism (PE) may be associated. Although often asymptomatic and with low recurrence risk, the best therapy is controversial. Purpose To study the results of oral anticogulation (OAC) in this population. Methods Retrospective single-centre study (2015–2020) of pts with asymptomatic PE diagnosed after a paradoxical stroke due to a PFO. Results Forty pts were included. Mean age was 56 ± 11 years and 55% were female. At diagnosis, 27.5%, 50.0%, 17.5% and 5.9% had none, weak, moderate and strong predisposing factors for PE, respectively. Most pts had peripheral events: 60.0% subsegmental, 37.5% segmental and 2.5% lobar. Regarding treatment, 97.5% initiated OAC (90.0% direct OAC, 7.5% vitamin K antagonist); 1 pt single antiaggregation; 30% had percutaneous PFO closure. Mean clinical follow-up (FUP) was 32 ± 22 months. There was 1 recurrent PE and 1 non-cardiovascular death. Mean time under OAC (TUOAC) was 27 ± 26 months. The only predictor of OAC suspension was PFO closure (17.9% vs. 50.0%, P = 0.037). Of these pts, 50.0% suspended OAC after the procedure (TUOAC 23.2 ± 17.9 months); the remaining had a TUOAC of 28.9 ± 29.9 months. Age or PE predisposing factors were not associated with OAC suspension or TUOAC. There were 3 clinically relevant haemorrhagic events (1 BARC3a,1 BARC3b, 1 BARC3c). TUOAC was neither associated with bleeding (P = 0.307) nor with perfusion defects resolution in FUP scintigraphy (55.5 vs. 16.0 months, P = 0.172). Conclusions TUOAC was not associated with perfusion defects resolution, ischemic or bleeding events. Management of these pts needs more evidence and consensus.
Poster No. 095 The predictors of clinical outcome in the patients undergoing endovascular intervention for lower extremity peripheral arterial disease
Authors: Kim Byung Ok
Journal: Cardiovascular Research (2022)

Abstract Background Patients with peripheral arterial disease (PAD) have a higher mortality rate than patients without PAD. This study aimed to identify the predictors of mortality outcomes in patients with peripheral artery disease undergoing lower extremity endovascular interventions. Materials and methods We studied 300 consecutive patients admitted for symptomatic PAD. A 196 patients without angina and prior coronary revascularization (72 ± 10 years, 156 men) who underwent lower extremity endovascular intervention (claudication, n = 74; critical limb ischemia, n = 122) were retrospectively analyzed. Results: During follow-up, all-cause mortality and MACCE at 3 year were 16.3% and 19.8%, respectively. The independent risk factors for all-cause mortality were old age (HR = 1.05, P = 0.043), lower body mass index (HR = 0.83, P = 0.016), critical limb ischemia (HR = 3.74, P = 0.033) and the presence of CAD (HR = 2.85, P = 0.027). This variable surpassed all classical risk factors (including smoking and history of hypertension or diabetes mellitus). Of the 196 patients, 101 patients (52%) had asymptomatic CAD; 1-VD (n = 35, 18%); 2-VD (n = 32, 16%); 3-VD (n = 28, 14%). At 3 year follow-up, patients with CAD had significantly higher all-cause mortality (19% vs. 11%, P = 0.018) and higher MACCE rate (26% vs. 8%, P = 0.001) compared to those without CAD. Conclusions Asymptomatic coronary artery disease (CAD) was found in half of the patients undergoing endovascular intervention for PAD and associated with higher mortality and MACCE rate. Therefore, detection of CAD might be important for risk stratification for these patients, especially with lower body mass index or critical limb ischemia.
Poster No. 017 Cardioembolic Stroke at Prosthetic valve endocarditis
Authors: Eneida Hoxha, Elvana Rista, Somida Kuka, Ledio Collaku, Jona Musabelliu, Jorida Djamandi, Margarita Gjata
Journal: Cardiovascular Research (2022)

Abstract Background Embolic events are frequent and life-threatening complications of infective endocarditis (IE), related to the migration of cardiac vegetations. Risk of embolism is very high in IE, with embolic events occurring in 20–50% of patients. The brain and spleen are the most common sites of embolism in left-sided IE. Stroke is a severe complication and is associated with increased morbidity and mortality rates. Case presentation A 73-year-old male presented to the Emergency Department, in May 2022 with right hemiparesis, aphasia and fever (38°C). He reported of a two day history of recurrent fever. His pre-existing comorbities included Diabetes Mellitus, Arterial Hypertension, and Atrial Fibrillation on anticoagulation therapy with Acenocoumarole and INR levels within normal range. His past medical history was significant for an Aortic Valve Replacement, in September 2021 and a subsequent hospitalization in January 2022 with Prosthetic Valve Endocarditis. At the time, he presented with recurrent fever up to 38.8°C, no significant findings in the transthoracic echocardiogram (TTE) and positive blood cultures for Enterococcus faecalis. He was started on antibiotic therapy. Laboratory and imaging studies in his latest admission revealed a cardioembolic stroke. Conclusion Infective endocarditis can present with a wide variety of symptoms and early diagnosis can be challenging. Establishing the diagnosis early in the course of the disease, would enable a prompt implementation of empiric antibiotic therapy, potentially preventing serious complications. Keeping a high index of suspicion when evaluating patients at high risk for IE, might lead to more favorable outcomes of major complications associated with it.
Oral Presentation No. 48 Sex-based differences in patients with peripheral arterial disease admitted for acute coronary syndrome - Insights from a multicentre national registry
Authors: Margarida Cabral, Carolina Gonçalves, Sara Fernandes, Mariana Carvalho, Catarina Ruivo, Sidarth Pernencar, Maria Fátima Loureiro, João Morais
Journal: Cardiovascular Research (2022)

Abstract Atherosclerosis represents a systemic disease that can involve multiple vascular beds, including coronary artery disease and peripheral artery disease (PAD). Acute coronary syndrome (ACS) with concomitant PAD represents a high-risk subgroup that deserves special attention. In particular, sex-based differences in PAD treatment and outcomes have been discussed. This study aimed to clarify the main differences in clinical outcomes between women and men with PAD admitted for ACS. The authors performed a retrospective analysis of adult patients with PAD, included in the Portuguese Registry on Acute Coronary Syndromes (ProACS) between October 2010 and July 2022. A P-value &amp;lt; 0.05 is statistically significant. Of the total of 32 251 hospitalized patients admitted for ACS, 1588 (4.9%) had known PAD, of which 320 were women and 1268 men. Table 1 shows the most important baseline characteristics and differences between groups. After propensity score matching, with 640 patients, female gender appeared to be an independent factor for acute heart failure (OR 0.68, 95% CI [0.48, 0.96], P-value = 0.03) and in-hospital mortality (OR 0.36, 95% CI [0.17, 0.73], P-value &amp;lt; 0.01). However, there are no differences between sex for 1-year mortality (P-value = 0.70). In conclusion, in this group of patients, PAD is less prevalent among women, and probably underdiagnosed. In addition, there is a significant difference in medication with fewer women taking acetylsalicylic acid, probably undertreated. Finally, women have more in-hospital complications, including mortality. Hence, additional efforts are needed in order to better understand sex-based differences in PAD and increase awareness of this condition in women.
Clinical Case 22—When the unusual appears
Authors: Ana Margarida de Abreu Temtem, Débora Sá, Marina Santos, Sofia Leça, Ricardo Rodrigues, Gomes Serrão, Bruno Silva, Graça Caires, António Brazão, João Manuel Rodrigues, Drumond Freitas
Journal: Cardiovascular Research (2022)

Abstract Clinical case A 57 years old female, smoker, presented to emergency department with a constrictive chest and epigastric pain lasting for 30 minutes. Admission electrocardiogram showed a sinus bradycardia and ST elevation in the inferior leads. Inferior STEMI was assumed and was referred for primary coronary intervention. Coronary angiography revealed a right coronary artery (RCA) occluded at ostial level and primary angioplasty was performed with drug eluting stent implantation. After angioplasty, the chest pain didn´t relief, although the procedure had no complications. Transthoracic echocardiogram revealed a ‘flap’ on the ascending aorta (AAo), suggesting dissection of the AAo; left ventricular systolic function preserved, with hypokinesia of the inferior wall; right ventricular dysfunction; aortic regurgitation and no pericardial effusion. Emerging angio CT confirmed type A aortic dissection extending to abdominal aorta. The patient was then admitted to the operating room and a supracoronary conduit (hemiarch) and a bypass (saphenous vein/RCA) procedure was done. She had progressive clinical improvement and was discharged on the 17th day. Learning points Acute aortic dissection is the most common acute aortic syndrome (AAoS), being more prevalent in males and in the elderly, presenting high mortality rate. Acute type A aortic dissection can be difficult to diagnose and can mimic STEMI. RCA is more often involved when myocardial infarction is present. What appeared to be a linear STEMI turned out to be an AAoS that could have a catastrophic outcome. This was a successful case of this unusual diagnosis that surprised the entire team.